Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia.
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
J Clin Densitom. 2021 Jul-Sep;24(3):453-459. doi: 10.1016/j.jocd.2020.10.002. Epub 2020 Oct 16.
Bone mineral density, measured by dual X-ray absorptiometry (DXA), is the gold standard for diagnosis of osteoporosis. The utility of DXA relies on the accuracy of scan acquisition, interpretation of data, and the adequacy of reports. The International Society for Clinical Densitometry (ISCD) has published guidelines regarding minimum reporting guidelines. This study assessed whether DXA reports for patients receiving care at an academic teaching hospital adhere to these reporting standards, and determine whether differences exist depending on patient factors and the imaging service.
Patients aged ≥18 years, receiving care at specialist outpatient clinics between January 1, 2018 and December 31, 2019, with a DXA report available, were eligible for inclusion. DXA reports were manually reviewed for adherence to ISCD guidelines, with each criterion scored as one point, giving a total score of 14 for baseline DXA scans and 18 for repeat DXA scans. The score was then converted to a percentage.
Of 459 DXA scans included, 214 were performed internally at our hospital and 245 performed at 23 external imaging services. Mean (SD) patient age was 60 (16.3) years, and 75.8% were female. The overall median (IQR) report score was 57.1% (42.9, 82.4). ISCD criteria with the lowest scores were recommendation and timing of future DXA scans (included in 1.1% of reports) and investigation for secondary causes of osteoporosis (included in 1.2% of reports). Reports performed internally had significantly higher scores than those performed externally, after adjusting for age, sex, indication, and type of scan (incidence rate ratio 1.83, 95% confidence interval 1.77, 1.89). Baseline DXA reports had slightly higher scores than repeat DXA scans, and, among external imaging services, rural services had higher scores than metropolitan services.
This study, the largest comprehensive evaluation of DXA reports, highlights significant deficiencies and variation in report standards between imaging services. This has potential implications for osteoporosis diagnosis and management.
通过双能 X 射线吸收法（DXA）测量的骨密度是骨质疏松症诊断的金标准。DXA 的应用依赖于扫描采集的准确性、数据解释和报告的充分性。国际临床密度测定学会（ISCD）已经发布了关于最低报告准则的指南。本研究评估了在学术教学医院接受治疗的患者的 DXA 报告是否符合这些报告标准，并确定是否因患者因素和成像服务的不同而存在差异。
年龄≥18 岁、2018 年 1 月 1 日至 2019 年 12 月 31 日在专科门诊就诊且有 DXA 报告的患者符合入选条件。对 DXA 报告进行了手动审查，以确定其是否符合 ISCD 指南，每个标准得 1 分，基线 DXA 扫描得分为 14 分，重复 DXA 扫描得分为 18 分。然后将分数转换为百分比。
共纳入 459 例 DXA 扫描，其中 214 例在我院内部进行，245 例在 23 家外部影像服务机构进行。患者平均（SD）年龄为 60（16.3）岁，75.8%为女性。总体中位数（IQR）报告评分为 57.1%（42.9，82.4）。评分最低的 ISCD 标准是未来 DXA 扫描的建议和时间（1.1%的报告中包含）和骨质疏松继发原因的检查（1.2%的报告中包含）。在校正年龄、性别、适应证和扫描类型后，内部报告的评分明显高于外部报告（发病率比 1.83，95%置信区间 1.77，1.89）。基线 DXA 报告的评分略高于重复 DXA 扫描，在外部影像服务机构中，农村服务机构的评分高于城市服务机构。
这项迄今为止对 DXA 报告最全面的评估研究，突出了成像服务之间报告标准的显著缺陷和差异。这可能对骨质疏松症的诊断和管理有影响。
